VENDOR APPLICATION FORM __________________________ Page 1 of 16 CONFIDENTIAL IMPORTANT NOTICE OUR PAYMENT TERMS ARE NETT 90 DAYS FROM MONTH END STATEMENT. PLEASE SIGN YOUR ACKNOWLEDGEMENT AND ACCEPTANCE OF THESE TERMS. WITHOUT AGREEMENT ON THIS YOUR VENDOR APPLICATION CAN NOT BE CONSIDERED FOR APPROVAL. _________________________ or _______________________ CEO / MD BRANCH MANAGER AND ____________________________ FD/FINANCIAL MANAGER
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VENDOR APPLICATION FORM
__________________________
Page 1 of 16 CONFIDENTIAL
IMPORTANT NOTICE
OUR PAYMENT TERMS ARE NETT 90 DAYS FROM MONTH END
STATEMENT. PLEASE SIGN YOUR ACKNOWLEDGEMENT AND
ACCEPTANCE OF THESE TERMS. WITHOUT AGREEMENT ON THIS
YOUR VENDOR APPLICATION CAN NOT BE CONSIDERED FOR
APPROVAL.
_________________________ or _______________________
CEO / MD BRANCH MANAGER
AND
____________________________
FD/FINANCIAL MANAGER
VENDOR APPLICATION FORM
__________________________
Page 2 of 16 CONFIDENTIAL
EVRAZ HIGHVELD STEEL AND VANADIUM
LIMITED
VENDOR APPLICATION FORM
__________________________
Page 3 of 16 CONFIDENTIAL
VENDOR REGISTRATION
1. General Information
1.1 Completion of Forms
In order to ensure that your application form is successfully registered, please adhere to the checklist as detailed below: All information disclosed will be treated as highly confidential. All fields in the form must be completed. Where they are not applicable to the
applicant, they can be marked as “N/A”. Sign page15. Ensure that all the documentation that is relevant to your organisation is
attached – refer to the checklist on page 14. Keep a copy of the vendor application form and attached documentation and
advise Evraz Highveld Steel and Vanadium Limited of any amendments Post or deliver completed vendor application form to:
Postal address: Delivery address:
Evraz Highveld Steel and Vanadium Limited
Evraz Highveld Steel and Vanadium Limited
PO Box 111 Administration Block
eMalahleni Portion 93 of the Farm Schoongezicht, 308 JS, Old Pretoria Road
1035 eMalahleni
Attention: Ms Heleen van Heerden Attention: Ms Heleen van Heerden
Completed Vendor Application Forms are, following processing and verification, forwarded to the Evraz Highveld Steel and Vanadium Limited Vendor Management Committee for approval. Once approved the Vendor Application Form will be subject to a bank verification and a security check.
VENDOR APPLICATION FORM
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VENDOR APPLICATION FORM
2 Vendor Registration Form
2.1 Organisation Details
Full Name of Organisation
Registration Number
Web Address
VAT Registration Number
2.2 Address and Contact Information
Telephone Number (Include area code)
Fax Number (Include area code)
E-mail Address
Physical Address (Include suburb and city) Postal Address (Include suburb and city)
Postal Code
Province
Country
VENDOR APPLICATION FORM
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2.3 Contact Person
Managing Director / Owner Contact Name
Contact Number Contact Fax Number
E-mail
Sales Representative Contact Name
Contact Number Contact Fax Number
E-mail
Accounts Contact Name
Contact Number Contact Fax Number
Contact E-mail
Technical Representative Contact Name
Contact Number Contact Fax Number
E-mail
VENDOR APPLICATION FORM
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2.4 Trade References
Please provide two references of customers and two references of suppliers that your organisation has dealt with in the last two years.
Customers Customer 1: Organisation‟s Name
Customer Contact Person Customer Contact Number
Scope of goods, work and or service rendered
Customer 2: Organisation‟s Name
Customer Contact Person Customer Contact Number
Scope of goods, work and or service rendered
Suppliers Supplier 1: Organisation‟s Name
Supplier Contact Person Supplier Contact Number
Supplier 2: Organisation‟s Name
Supplier Contact Person Supplier Contact Number
VENDOR APPLICATION FORM
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2.5 List of Products and Services
Please state your main areas of business/specialisation in detail below and select suitable categories of supply:
ABRASIVES FAN REPAIR SERVICES OXYGEN
AIR CONDITIONING FANS PACKAGING MATERIALS
AIR CONDITIONING MAINTENANCE AND INSTALLATION FASTENERS PAINTING INDUSTRIAL
AIR FLOW DESIGN FASTENERS (SPECIALIZED TORQUE WRENCH ONLY) PALLET REPAIRS
ALUMINIUM BARS FENCING - ELECTRICAL PANEL BEARING
ALUMINIUM DROPLETS FENCING - NON-ELECTRICAL PANEL BUILDING
FABRICATION HEAVY (SLAGPOTS) ON-SITE MAINTENANCE - SCAFFOLDING WINDSCREEN REPALCEMENTS
FABRICATION SERVICES (HEAVY) OFF SITE ON-SITE MAINTENANCE - SHEET WOOD - OFF CUT
FABRICATION SERVICES OFF SITE ON-SITE MAINTENANCE STRUCTURAL WOOD PRODUCTS
VENDOR APPLICATION FORM
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Page 10 of 16 CONFIDENTIAL
2.6 Ownership and Demographics
The following information will remain confidential at all times and will only be used for reference and reporting purposes within Evraz Highveld Steel and Vanadium Geographic areas of business
Gauteng Western Cape Eastern Cape
Northern Cape Free State Mpumalanga
Kwa-Zulu Natal North West Limpopo
Gross asset value
<R2 million <R25 million <R50 million >R50 million
Annual turnover
<R2 million <R20 million <R50 million >R50 million
Period that organisation has been in operation
Total number of permanent employees
<10 <50 <150 <200 >200
Demographics of shareholders, directors, partners, members or owners of the organisation
Name ID No. Race Gender Position
Held % Share-holding
VENDOR APPLICATION FORM
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2.7 Security
If yes, please supply full details.
If yes, please supply full details.
Name of all relatives, employed at Evraz Highveld Steel and Vanadium Limited, if any
Name of person(s)
If yes, please state when, where and what the offence was.
If yes, please supply full details.
List the name/s of all other businesses in which a shareholder, director, partner, member or owner of the organisation currently is or has been involved with.
Full name Name of business
Have any of the above directors, partners, owners or members been sequestrated?
Yes No
Has the organisation ever been liquidated or declared insolvent? Yes No
Has any director, member or employee, including hired labour, been convicted of any criminal offence?
Yes No
Has your organisation ever been investigated or rejected by any other company, as a result of security reasons?
Yes No
VENDOR APPLICATION FORM
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Page 12 of 16 CONFIDENTIAL
2.8 Black Economic Empowerment Status
Has your organisation undergone a formal broad based black economic empowerment (BBBEE) accreditation?
Yes No
Provide the name of the accreditation agency
Indicate your level of accreditation (mark with X)
Indicate the status of your accreditation in respect of the following (mark with X). (If accreditation has been awarded please attach a copy of the certification) : TYPE OF ACCREDITATION
IN PROCESS PLANNED DATE OF ACCREDITATION
ISSUING BODY / ORGANISATION
YEAR ACCREDITATION OBTAINED
ISO 9001 :2000
If ACCREDITED, please provide the following information and then proceed to Environmental Management Systems
Certification number
Name of the certificating body
If NOT ACCREDITED, please answer the following questions:
Is your current system fully documented (i.e. procedures / work instructions, etc.)? Please provide copies of system documentation.
Yes No
Is your current system subject to audits by independent and qualified personnel?
Yes No
Are management reviews conducted regularly? Yes No
Are quality control plans of similar systems in operation? Yes No
VENDOR APPLICATION FORM
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Environmental Management System Indicate the status of your accreditation in respect of the following (mark with X). (If certification has been awarded please attach a copy of the certification) : TYPE OF ACCREDITATION
IN PROCESS PLANNED DATE OF CERTIFICATION
ISSUING BODY / ORGANISATION
YEAR CERTIFICATION OBTAINED
ISO 14001
If CERTIFIED, please provide the following information and then proceed to Occupational Health and Safety Management Systems
Certification number
Name of the certificating body
If NOT CERTIFIED, please answer the following questions:
Has an environmental policy been documented by management? Please provide copies of system documentation.
Yes No
Have you determined the significant environmental aspects pertaining to your business?
Yes No
Have you addressed the resultant impacts through formal procedures for the „prevention of pollution‟ by setting objectives and targets and established management programmers in this regard?
Yes No
Have you identified the relevant sections of the legislation that is applicable to the nature and scope of your business operations?
Yes No
Are these being complied with? Yes No
If you have answered NO to any of the above questions, briefly explain your current environmental management system
VENDOR APPLICATION FORM
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Page 14 of 16 CONFIDENTIAL
Occupational Health and Safety Management System If you are a manufacturer, please provide your organisation‟s Lost Time Incident Frequency Rate (LTIFR) for the last 12 months ?
Indicate the status of your accreditation in respect of the following (mark with X). (If accreditation has been awarded please attach a copy of the certification) :
TYPE OF CERTIFICATION
IN PROCESS PLANNED DATE OF CERTIFICATION
ISSUING BODY / ORGANISATION
YEAR CERTIFICATIONOBTAINED
OHSAS 18001:1999
If CERTIFIED, please provide the following information and then proceed to 2.10 Payment Details
Certification number
Name of the certificating body
If CERTIFIED, please answer the following questions:
Have you developed an OHSAS policy? Please provide copies of system documentation.
Yes No
Has the OHSAS policy been communicated to all employees? Yes No
Have you identified occupational health and safety hazards resulting from your business operations?
Yes No
Have the risks associated with the hazards been assessed and or evaluated?
Yes No
Are there safe work procedures and or instructions addressing the significant risks?
Yes No
Are your employees aware of the hazards and risks pertaining to the work and or tasks being performed?
Yes No
Are the relevant sections of OHS Act applicable to your business operations complied with?
Yes No
If you have answered NO to any of the above questions, briefly explain your current OHSAS management system
VENDOR APPLICATION FORM
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2.10 Payment Details
The Vendor hereby instructs and authorises the Company to pay amounts which may be due to the Vendor by transfer of such amounts to credit the Vendor‟s bank account and attach at least one of the following as proof: o Original cancelled cheque; o Original letter on bank letterhead signed and stamped by the bank
confirming that the account number is held in the name of the Vendor;
Standard Payment Terms for Highveld Steel : 90 DAYS NETT – FROM MONTH END STATEMENT
2.11 Attachments
Please attach copies of your company documentation:
Yes No N/A
Company registration
Registration certificate for Workmen‟s Compensation Fund
Registration certificate for Unemployment Insurance Fund (UIF)
Income tax registration
VAT registration
VAT exemption
Ownership transformation plan
BEE Accreditation Certificate
Quality, environmental and occupational health and safety system documentation
We, the undersigned, duly authorised to provide all the details contained in this Vendor Application Form, and to further authorise Evraz Highveld Steel and Vanadium Limited, to at any time and by whatever means necessary obtain a complete Company Profile relating to our business operations which shall without limitation include :
Names of directors
Financial details
Court cases pending
Movable assets and the like
VENDOR APPLICATION FORM
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Page 16 of 16 CONFIDENTIAL
We also acknowledge that we have taken note of the attachments and declare that all information we supplied is correct and complete and that we will keep you informed should any of this information change in the future. In signing this document you agree to trade on EH terms and conditions of order or contract as applicable. Any quotation making a different statement will be disregarded no matter the wording of the quotation. These are the terms agreed to between EH and your Company unless otherwise agreed to in writing by both parties. To be completed and signed by an authorised representative : Signed at on this day of 2015